{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:27Z","timestamp":1785545067208,"version":"3.56.0"},"reference-count":116,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Digital health interventions (DHIs) are increasingly used to support antiretroviral therapy (ART) management among people living with HIV. However, existing systematic reviews have largely focused on single intervention types or limited outcomes, and few have integrated multiple DHI modalities across both behavioral and clinical end points. Additionally, previous evidence has rarely incorporated analytical approaches, such as prediction intervals (PIs) or trial sequential analysis (TSA), leaving uncertainty regarding the robustness and generalizability of findings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This systematic review aimed to evaluate the effectiveness of DHIs in improving ART-related outcomes among people living with HIV.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We systematically searched PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) published up to February 29, 2026. Eligible studies included people living with HIV receiving ART and evaluated DHIs, such as SMS, mobile apps, phone calls, adherence monitoring devices, multimedia education, or multicomponent interventions. Outcomes included viral suppression, CD4\n +<\/jats:sup>\n cell count, adherence, and retention. Random-effects meta-analyses were conducted using restricted maximum likelihood estimation with Hartung-Knapp-Sidik-Jonkman adjustment. Effect sizes were reported as risk ratios (RRs) or mean differences (MDs) with 95% CIs and 95% PIs. TSA was performed to assess the sufficiency of cumulative evidence. A frequentist network meta-analysis was conducted to compare the relative effectiveness of different DHIs.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 64 RCTs involving 22,286 participants were included. Compared with standard of care (SOC), DHIs improved subjective adherence (RR 1.13, 95% CI 1.04\u20101.23; 95% PI 0.82\u20101.57) and retention (RR 1.06, 95% CI 1.01\u20101.12; 95% PI 0.81\u20101.39). Viral suppression was modestly improved (RR 1.04, 95% CI 1.01\u20101.07; 95% PI 0.96\u20101.13), while no significant effect was observed for CD4\n +<\/jats:sup>\n cell count and objective adherence. TSA indicated sufficient evidence for viral suppression and subjective adherence but inconclusive evidence for other outcomes. In the network meta-analysis, SMS, mobile apps, and multicomponent interventions demonstrated statistically significant benefits versus SOC; however, all PIs crossed the null. Although phone calls ranked highest by surface under the cumulative ranking curve (SUCRA), differences between interventions were not robust.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In contrast to previous systematic reviews that focused on single intervention types or limited outcomes, this systematic review provides a comprehensive synthesis of multiple outcomes across all types of DHIs, supporting their potential role as nonpharmacological strategies in HIV care. However, the wide 95% PI, together with a high risk of bias, small-study effects, and low to very low certainty of evidence based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation), indicate substantial uncertainty regarding the true effects in future settings. Therefore, these findings should be interpreted with caution. These findings have important practical implications, as they may directly help inform the design of more targeted and context-specific digital interventions and highlight the need for further research to identify optimal implementation strategies in routine HIV care.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/81019","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:47:31Z","timestamp":1784832451000},"page":"e81019-e81019","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Digital Health Interventions for Improving Antiretroviral Therapy Outcomes in People With HIV: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3285-0347","authenticated-orcid":false,"given":"Pan","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0511-3365","authenticated-orcid":false,"given":"Jiahao","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8389-8463","authenticated-orcid":false,"given":"Xi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4048-4380","authenticated-orcid":false,"given":"Yilin","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8350-2577","authenticated-orcid":false,"given":"Xuanyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8812-7419","authenticated-orcid":false,"given":"Yuqing","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1135-7876","authenticated-orcid":false,"given":"Shuguang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"R1","unstructured":"HIV data and statistics. World Health Organization. URL: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/strategic-information\/hiv-data-and-statistics [Accessed 11-03-2026]"},{"issue":"9903","key":"R2","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1016\/S0140-6736(13)61809-7","article-title":"The end of AIDS: HIV infection as a chronic disease","volume":"382","author":"Deeks","journal-title":"Lancet"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/QCO.0b013e32835ba6b1","article-title":"Life expectancy living with HIV: recent estimates and future implications","volume":"26","author":"Nakagawa","journal-title":"Curr Opin Infect Dis"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1236460","article-title":"Recent advances in poor HIV immune reconstitution: what will the future look like?","volume":"14","author":"Zhang","journal-title":"Front Microbiol"},{"key":"R5","unstructured":"Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Clinicalinfo.HIV.gov. URL: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/adult-and-adolescent-arv [Accessed 11-03-2026]"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"167","DOI":"10.2174\/187152611795589663","article-title":"HIV treatment adherence, drug resistance, virologic failure: evolving concepts","volume":"11","author":"Nachega","journal-title":"Infect Disord Drug Targets"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab032","article-title":"Association of incomplete adherence to antiretroviral therapy with cardiovascular events and mortality in virologically suppressed persons with HIV: the Swiss HIV cohort study","volume":"8","author":"Castillo-Mancilla","journal-title":"Open Forum Infect Dis"},{"key":"R8","unstructured":"Classification of digital health interventions v1.0. World Health Organization. URL: https:\/\/www.who.int\/publications\/i\/item\/WHO-RHR-18.06 [Accessed 02-03-2026]"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.2196\/68352","article-title":"Technology-assisted interventions in the delivery of HIV prevention, care, and treatment services in Sub-Saharan Africa: scoping review","volume":"27","author":"Kamulegeya","journal-title":"J Med Internet Res"},{"key":"R10","unstructured":"Facts and figures 2024. International Telecommunication Union. URL: https:\/\/www.itu.int\/itu-d\/reports\/statistics\/facts-figures-2024\/index\/ [Accessed 12-03-2026]"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9031","article-title":"Acceptability and feasibility of real-time antiretroviral therapy adherence interventions in rural Uganda: mixed-method pilot randomized controlled trial","volume":"6","author":"Musiimenta","journal-title":"JMIR Mhealth Uhealth"},{"issue":"4","key":"R12","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/j.jadohealth.2020.11.016","article-title":"A single-blind, parallel design RCT to assess the effectiveness of SMS reminders in improving ART adherence among adolescents living with HIV (STARTA Trial)","volume":"68","author":"Abiodun","journal-title":"J Adolesc Health"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1007\/s11904-022-00623-z","article-title":"HIV care meets telehealth: a review of successes, disparities, and unresolved challenges","volume":"19","author":"Labisi","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-024-00645-1","article-title":"Recommendations for the equitable integration of digital health interventions across the HIV care cascade","volume":"4","author":"Gogishvili","journal-title":"Commun Med (Lond)"},{"issue":"6","key":"R15","doi-asserted-by":"publisher","DOI":"10.2196\/14649","article-title":"Technical and psychosocial challenges of mHealth usage for antiretroviral therapy adherence among people living with HIV in a resource-limited setting: case series","volume":"4","author":"Ngowi","journal-title":"JMIR Form Res"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/48739","article-title":"An mHealth platform for people with HIV receiving care in Washington, district of Columbia: qualitative analysis of stakeholder feedback","volume":"7","author":"Caldwell","journal-title":"JMIR Form Res"},{"issue":"9755","key":"R17","doi-asserted-by":"publisher","first-page":"1838","DOI":"10.1016\/S0140-6736(10)61997-6","article-title":"Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial","volume":"376","author":"Lester","journal-title":"Lancet"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/QAI.0000000000001020","article-title":"Randomized factorial trial of phone-delivered support counseling and daily text message reminders for HIV treatment adherence","volume":"73","author":"Kalichman","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"R19","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1093\/cid\/ciy156","article-title":"A randomized controlled trial of a text messaging intervention to promote virologic suppression and retention in care in an urban safety-net human immunodeficiency virus clinic: the Connect4Care trial","volume":"67","author":"Christopoulos","journal-title":"Clin Infect Dis"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/42799","article-title":"Effectiveness of mHealth on adherence to antiretroviral therapy in patients living with HIV: meta-analysis of randomized controlled trials","volume":"11","author":"Sun","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6899-6","article-title":"A systematic review and meta-analysis in the effectiveness of mobile phone interventions used to improve adherence to antiretroviral therapy in HIV infection","volume":"19","author":"Shah","journal-title":"BMC Public Health"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-023-08119-w","article-title":"Does telehealth affect the adherence to ART among patients with HIV? A systematic review and meta-analysis","volume":"23","author":"Esmaeili","journal-title":"BMC Infect Dis"},{"issue":"3","key":"R23","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1177\/1357633X211070726","article-title":"Effects of telehealth-assisted interventions among people living with HIV\/AIDS: a systematic review and meta-analysis of randomized controlled studies","volume":"30","author":"Saragih","journal-title":"J Telemed Telecare"},{"issue":"3","key":"R24","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1080\/09540121.2025.2591809","article-title":"Effectiveness of mobile health (mHealth) interventions on ART adherence among people living with HIV in low- and middle-income countries: a systematic review and meta-analysis","volume":"38","author":"Tang","journal-title":"AIDS Care"},{"issue":"3","key":"R25","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1093\/aje\/kwae260","article-title":"Introduction to network meta-analysis: understanding what it is, how it is done, and how it can be used for decision-making","volume":"194","author":"Brignardello-Petersen","journal-title":"Am J Epidemiol"},{"issue":"10","key":"R26","doi-asserted-by":"publisher","first-page":"782","DOI":"10.2471\/BLT.16.174326","article-title":"Use of network meta-analysis in clinical guidelines","volume":"94","author":"Kanters","journal-title":"Bull World Health Organ"},{"issue":"8","key":"R27","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9735","article-title":"Use of prediction intervals in network meta-analysis","volume":"2","author":"Lin","journal-title":"JAMA Netw Open"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.18549\/PharmPract.2017.01.943","article-title":"Network meta-analysis: a technique to gather evidence from direct and indirect comparisons","volume":"15","author":"Tonin","journal-title":"Pharm Pract (Granada)"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","journal-title":"BMJ"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01542-z","article-title":"PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews","volume":"10","author":"Rethlefsen","journal-title":"Syst Rev"},{"key":"R31","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions. Cochrane. URL: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current [Accessed 01-04-2026]"},{"key":"R32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"Moore","journal-title":"BMJ"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","journal-title":"Adm Policy Ment Health"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2019.00064","article-title":"RE-AIM planning and evaluation framework: adapting to new science and practice with a 20-year review","volume":"7","author":"Glasgow","journal-title":"Front Public Health"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2024.104705","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"154","author":"Skivington","journal-title":"Int J Nurs Stud"},{"issue":"oct18 2","key":"R36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","journal-title":"BMJ"},{"key":"R37","unstructured":"McMaster University and Evidence Prime. GRADEpro GDT: GRADEpro Guideline Development Tool. 2023. URL: https:\/\/gradepro.org\/ [Accessed 13-07-2026]"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-25","article-title":"The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method","volume":"14","author":"IntHout","journal-title":"BMC Med Res Methodol"},{"issue":"4","key":"R39","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2023.101014","article-title":"How to understand and report heterogeneity in a meta-analysis: the difference between I-squared and prediction intervals","volume":"12","author":"Borenstein","journal-title":"Integr Med Res"},{"issue":"3","key":"R40","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s10461-024-04560-3","article-title":"Randomized pilot trial of the text-based adherence game for Ghanaian youth with HIV","volume":"29","author":"Tarantino","journal-title":"AIDS Behav"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.2196\/57540","article-title":"Effectiveness of an mHealth intervention with short text messages to promote treatment adherence among HIV-positive Mexican adults: randomized controlled trial","volume":"13","author":"Del Moral Trinidad","journal-title":"JMIR Mhealth Uhealth"},{"issue":"11","key":"R42","doi-asserted-by":"publisher","first-page":"3703","DOI":"10.1007\/s10461-025-04811-x","article-title":"Efficacy of CHAMPS for improving viral suppression: a randomised clinical trial","volume":"29","author":"Schnall","journal-title":"AIDS Behav"},{"issue":"11","key":"R43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0308923","article-title":"Effectiveness of interactive voice response-call for life mHealth tool on adherence to anti-retroviral therapy among young people living with HIV: a randomized trial in Uganda","volume":"19","author":"Bwanika Naggirinya","journal-title":"PLoS ONE"},{"issue":"1","key":"R44","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/QAI.0000000000003639","article-title":"Positive STEPS: enhancing medication adherence and achieving viral load suppression in youth living with HIV in the United States-results from an efficacious stepped care, randomized controlled trial","volume":"99","author":"Mimiaga","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1097\/QAI.0000000000003045","article-title":"Effectiveness of an interactive, highly tailored \u201cVideo Doctor\u201d intervention to suppress viral load and retain patients with HIV in clinical care: a randomized clinical trial","volume":"91","author":"Lewis","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"R46","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1097\/QAI.0000000000000770","article-title":"A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy","volume":"70","author":"Orrell","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"R47","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1097\/QAI.0000000000000651","article-title":"Improving adherence to antiretroviral therapy with triggered real-time text message reminders: the China adherence through technology study","volume":"69","author":"Sabin","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"2","key":"R48","doi-asserted-by":"publisher","first-page":"171","DOI":"10.9745\/GHSP-D-18-00241","article-title":"Cell phone counseling improves retention of mothers with HIV infection in care and infant HIV testing in Kisumu, Kenya: a randomized controlled study","volume":"7","author":"Sarna","journal-title":"Glob Health Sci Pract"},{"issue":"4","key":"R49","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1097\/qai.0b013e3181b9300c","article-title":"Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial","volume":"52","author":"Simoni","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"sup4","key":"R50","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1080\/09540121.2018.1503224","article-title":"Enhancing health among youth living with HIV using an iPhone game","volume":"30","author":"Whiteley","journal-title":"AIDS Care"},{"issue":"3","key":"R51","doi-asserted-by":"publisher","first-page":"e143","DOI":"10.1016\/S2468-2667(17)30239-6","article-title":"Effect of an interactive text-messaging service on patient retention during the first year of HIV care in Kenya (WelTel Retain): an open-label, randomised parallel-group study","volume":"3","author":"van der Kop","journal-title":"Lancet Public Health"},{"issue":"6","key":"R52","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1177\/1545109710383175","article-title":"Efficacy of interventions for improving antiretroviral therapy adherence in HIV\/AIDS cases at PIMS, Islamabad","volume":"10","author":"Uzma","journal-title":"J Int Assoc Physicians AIDS Care (Chic)"},{"issue":"8","key":"R53","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25774","article-title":"Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three-arm cluster randomized controlled trial","volume":"24","author":"Steward","journal-title":"J Int AIDS Soc"},{"key":"R54","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5978","article-title":"Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India","volume":"349","author":"Shet","journal-title":"BMJ"},{"issue":"1","key":"R55","doi-asserted-by":"publisher","DOI":"10.1186\/s12981-020-00275-2","article-title":"Effect of mobile text messages on antiretroviral medication adherence and patient retention in early HIV care: an open-label, randomized, single center study in South Florida","volume":"17","author":"Sherman","journal-title":"AIDS Res Ther"},{"issue":"11","key":"R56","doi-asserted-by":"publisher","first-page":"3164","DOI":"10.1007\/s10461-020-02875-5","article-title":"Retention in HIV care among HIV-seropositive pregnant and postpartum women in Uganda: results of a randomized controlled trial","volume":"24","author":"Sabin","journal-title":"AIDS Behav"},{"issue":"1","key":"R57","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1089\/tmr.2020.0014","article-title":"Video-counseling intervention to address HIV care engagement, mental health, and substance use challenges: a pilot randomized clinical trial for youth and young adults living with HIV","volume":"2","author":"Saberi","journal-title":"Telemed Rep"},{"issue":"8","key":"R58","doi-asserted-by":"publisher","first-page":"e518","DOI":"10.1016\/S2352-3018(23)00118-2","article-title":"A multilevel health system intervention for virological suppression in adolescents and young adults living with HIV in rural Kenya and Uganda (SEARCH-Youth): a cluster randomised trial","volume":"10","author":"Ruel","journal-title":"Lancet HIV"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S120003","article-title":"Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-na\u00efve individuals","volume":"11","author":"Ruan","journal-title":"Patient Prefer Adherence"},{"issue":"11","key":"R60","doi-asserted-by":"publisher","first-page":"3782","DOI":"10.1007\/s10461-021-03342-5","article-title":"A preliminary test of an mHealth facilitated health coaching intervention to improve medication adherence among persons living with HIV","volume":"25","author":"Ramsey","journal-title":"AIDS Behav"},{"issue":"6","key":"R61","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1097\/QAD.0b013e32834380c1","article-title":"Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders","volume":"25","author":"Pop-Eleches","journal-title":"AIDS"},{"issue":"3","key":"R62","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/s10461-014-0971-0","article-title":"Individualized texting for adherence building (iTAB): improving antiretroviral dose timing among HIV-infected persons with co-occurring bipolar disorder","volume":"19","author":"Moore","journal-title":"AIDS Behav"},{"issue":"11","key":"R63","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002420","article-title":"Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial","volume":"14","author":"McNairy","journal-title":"PLoS Med"},{"issue":"12","key":"R64","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0046909","article-title":"The Cameroon Mobile Phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy","volume":"7","author":"Mbuagbaw","journal-title":"PLoS ONE"},{"issue":"3","key":"R65","doi-asserted-by":"publisher","first-page":"302","DOI":"10.4103\/1119-3077.113451","article-title":"Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria","volume":"16","author":"Maduka","journal-title":"Niger J Clin Pract"},{"issue":"3","key":"R66","doi-asserted-by":"publisher","first-page":"400","DOI":"10.17843\/rpmesp.2019.363.4139","article-title":"Text messaging to improve patient adherence in haart: randomized controlled trial","volume":"36","author":"Liz\u00e1rraga","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"R67","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2022.104330","article-title":"Ingestible sensor system for measuring, monitoring and enhancing adherence to antiretroviral therapy: an open-label, usual care-controlled, randomised trial","volume":"86","author":"Liu","journal-title":"EBioMedicine"},{"issue":"12","key":"R68","doi-asserted-by":"publisher","first-page":"1944","DOI":"10.2105\/AJPH.2017.304089","article-title":"Text messaging for improving antiretroviral therapy adherence: no effects after 1 year in a randomized controlled trial among adolescents and young adults","volume":"107","author":"Linnemayr","journal-title":"Am J Public Health"},{"issue":"11","key":"R69","doi-asserted-by":"publisher","first-page":"3140","DOI":"10.1007\/s10461-019-02634-1","article-title":"VITAL Start: video-based intervention to inspire treatment adherence for life-pilot of a novel video-based approach to HIV counseling for pregnant women living with HIV","volume":"23","author":"Kim","journal-title":"AIDS Behav"},{"issue":"4","key":"R70","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1111\/jrh.12618","article-title":"Randomized community trial comparing telephone versus clinic-based behavioral health counseling for people living with HIV in a rural setting","volume":"38","author":"Kalichman","journal-title":"J Rural Health"},{"issue":"1","key":"R71","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02538-3","article-title":"A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial","volume":"20","author":"Jiao","journal-title":"BMC Med"},{"key":"R72","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000295","article-title":"Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV","volume":"34S","author":"Ingersoll","journal-title":"Health Psychol"},{"issue":"9","key":"R73","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004598","article-title":"Evaluating the effect of interactive two-way texting on 6-month antiretroviral therapy outcomes: findings from a randomized controlled trial in Lilongwe, Malawi","volume":"5","author":"Kiruthu-Kamamia","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"R74","doi-asserted-by":"publisher","DOI":"10.1186\/s12981-025-00746-4","article-title":"The impact of short message service reminders or peer home visits on adherence to antiretroviral therapy and viral load suppression among HIV-infected adolescents in Cameroon: a randomized controlled trial","volume":"22","author":"Ketchaji","journal-title":"AIDS Res Ther"},{"key":"R75","doi-asserted-by":"publisher","DOI":"10.2196\/53819","article-title":"A web-based antiretroviral therapy adherence intervention (Thrive With Me) in a community-recruited sample of sexual minority men living with HIV: results of a randomized controlled study","volume":"26","author":"Horvath","journal-title":"J Med Internet Res"},{"key":"R76","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/580974","article-title":"Effects of a phone call intervention to promote adherence to antiretroviral therapy and quality of life of HIV\/AIDS patients in Baoshan, China: a randomized controlled trial","volume":"2013","author":"Huang","journal-title":"AIDS Res Treat"},{"issue":"6","key":"R77","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1007\/s10461-024-04289-z","article-title":"HealthCall: smartphone enhancement of brief interventions to improve HIV medication adherence among patients in HIV care","volume":"28","author":"Knox","journal-title":"AIDS Behav"},{"issue":"8","key":"R78","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1097\/QAD.0000000000001021","article-title":"Short message service (SMS) reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda","volume":"30","author":"Haberer","journal-title":"AIDS"},{"issue":"2","key":"R79","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.1097\/QAI.0000000000001115","article-title":"SMSa\u00fade: evaluating mobile phone text reminders to improve retention in HIV care for patients on antiretroviral therapy in Mozambique","volume":"73","author":"Davey","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"R80","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/QAI.0000000000002519","article-title":"Randomized pilot study of an advanced smart-pill bottle as an adherence intervention in patients with HIV on antiretroviral treatment","volume":"86","author":"Ellsworth","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"R81","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1097\/QAI.0000000000001882","article-title":"Effectiveness of a lay counselor-led combination intervention for retention of mothers and infants in HIV care: a randomized trial in Kenya","volume":"80","author":"Fayorsey","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"9","key":"R82","doi-asserted-by":"publisher","DOI":"10.2196\/10274","article-title":"Development and feasibility testing of an mHealth (text message and WeChat) intervention to improve the medication adherence and quality of life of people living with HIV in China: pilot randomized controlled trial","volume":"6","author":"Guo","journal-title":"JMIR Mhealth Uhealth"},{"issue":"5","key":"R83","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1007\/s10461-015-1192-x","article-title":"A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults","volume":"20","author":"Garofalo","journal-title":"AIDS Behav"},{"issue":"11","key":"R84","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002433","article-title":"A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: a cluster-randomized study","volume":"14","author":"Elul","journal-title":"PLoS Med"},{"issue":"6","key":"R85","doi-asserted-by":"publisher","DOI":"10.2196\/18343","article-title":"A social media-based support group for youth living with HIV in Nigeria (SMART Connections): randomized controlled trial","volume":"22","author":"Dulli","journal-title":"J Med Internet Res"},{"issue":"9","key":"R86","doi-asserted-by":"publisher","first-page":"2386","DOI":"10.1007\/s10461-019-02488-7","article-title":"Antiretroviral adherence following prison release in a randomized trial of the imPACT intervention to maintain suppression of HIV viremia","volume":"23","author":"DiPrete","journal-title":"AIDS Behav"},{"key":"R87","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2021.101318","article-title":"Smartphone-based incentives for promoting adherence to antiretroviral therapy: a randomized controlled trial","volume":"21","author":"DeFulio","journal-title":"Prev Med Rep"},{"issue":"4","key":"R88","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.ijmedinf.2011.10.002","article-title":"Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV\/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages","volume":"81","author":"da Costa","journal-title":"Int J Med Inform"},{"issue":"3","key":"R89","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1080\/09540121.2013.824534","article-title":"Pilot study examining the efficacy of an electronic intervention to promote HIV medication adherence","volume":"26","author":"Claborn","journal-title":"AIDS Care"},{"issue":"5","key":"R90","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s00737-024-01462-0","article-title":"Exploring the feasibility, acceptability and preliminary effects of a nurse delivered mHealth intervention for women living with HIV in South India: a pilot randomized controlled trial","volume":"27","author":"Satyanarayana","journal-title":"Arch Womens Ment Health"},{"issue":"5","key":"R91","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1097\/QAI.0000000000002695","article-title":"Effect of digital adherence tools on adherence to antiretroviral treatment among adults living with HIV in Kilimanjaro, Tanzania: a randomized controlled trial","volume":"87","author":"Sumari-de Boer","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"2","key":"R92","doi-asserted-by":"publisher","DOI":"10.2196\/22229","article-title":"An interactive voice response software to improve the quality of life of people living with HIV in Uganda: randomized controlled trial","volume":"9","author":"Byonanebye","journal-title":"JMIR Mhealth Uhealth"},{"issue":"4","key":"R93","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1007\/s10461-013-0661-3","article-title":"The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial","volume":"18","author":"Belzer","journal-title":"AIDS Behav"},{"issue":"6","key":"R94","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1007\/s10461-020-03122-7","article-title":"Nurse-led mobile phone voice call reminder and on-time antiretroviral pills pick-up in Nepal: a randomized controlled trial","volume":"25","author":"Ayer","journal-title":"AIDS Behav"},{"issue":"1","key":"R95","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-15638-3","article-title":"Randomized controlled trial of a theory-informed mHealth intervention to support ART adherence and viral suppression among women with HIV in Mombasa, Kenya: preliminary efficacy and participant-level feasibility and acceptability","volume":"23","author":"Aunon","journal-title":"BMC Public Health"},{"issue":"6","key":"R96","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1080\/09540121.2023.2299322","article-title":"Effectiveness of an intervention to improve ART adherence among men who have sex with men living with HIV: a randomized controlled trial in three public HIV clinics in Mexico","volume":"36","author":"Andrade-Romo","journal-title":"AIDS Care"},{"issue":"12","key":"R97","doi-asserted-by":"publisher","first-page":"3897","DOI":"10.1007\/s10461-022-03717-2","article-title":"Randomized controlled trial of a remote coaching mHealth adherence intervention in youth living with HIV","volume":"26","author":"Amico","journal-title":"AIDS Behav"},{"issue":"1","key":"R98","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25852","article-title":"Effects of behavioural interventions on postpartum retention and adherence among women with HIV on lifelong ART: the results of a cluster randomized trial in Kenya (the MOTIVATE trial)","volume":"25","author":"Abuogi","journal-title":"J Int AIDS Soc"},{"issue":"5","key":"R99","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0177698","article-title":"Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: a randomized clinical trial","volume":"12","author":"Abdulrahman","journal-title":"PLoS ONE"},{"issue":"10","key":"R100","doi-asserted-by":"publisher","DOI":"10.2196\/14404","article-title":"Electronic health interventions to improve adherence to antiretroviral therapy in people living with HIV: systematic review and meta-analysis","volume":"7","author":"Wang","journal-title":"JMIR Mhealth Uhealth"},{"key":"R101","doi-asserted-by":"publisher","DOI":"10.2196\/54375","article-title":"Digital behavior change intervention designs for habit formation: systematic review","volume":"26","author":"Zhu","journal-title":"J Med Internet Res"},{"issue":"12","key":"R102","doi-asserted-by":"publisher","DOI":"10.2196\/25129","article-title":"Behavioral theories and motivational features underlying eHealth interventions for adolescent antiretroviral adherence: systematic review","volume":"9","author":"Bezabih","journal-title":"JMIR Mhealth Uhealth"},{"key":"R103","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-7-104","article-title":"A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV\/AIDS?","volume":"7","author":"Munro","journal-title":"BMC Public Health"},{"issue":"2","key":"R104","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/01.COH.0000203834.24221.13","article-title":"Update on HIV-1 viral load blips","volume":"1","author":"Nettles","journal-title":"Curr Opin HIV AIDS"},{"issue":"RR-4","key":"R105","first-page":"1","volume":"58","author":"Kaplan","journal-title":"MMWR Recomm Rep"},{"issue":"8","key":"R106","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1097\/QAD.0000000000001801","article-title":"Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa","volume":"32","author":"Kroeze","journal-title":"AIDS"},{"issue":"6","key":"R107","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125248","article-title":"Quantitative assessment of intra-patient variation in CD4+ T cell counts in stable, virologically-suppressed, HIV-infected subjects","volume":"10","author":"Gordon","journal-title":"PLoS ONE"},{"issue":"8","key":"R108","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1089\/apc.2022.0062","article-title":"The boundary of HIV care: barriers and facilitators to care engagement among people with HIV in the United States","volume":"36","author":"Padilla","journal-title":"AIDS Patient Care STDS"},{"issue":"1","key":"R109","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-0990-0","article-title":"Barriers and facilitators to patient retention in HIV care","volume":"15","author":"Yehia","journal-title":"BMC Infect Dis"},{"issue":"1","key":"R110","doi-asserted-by":"publisher","DOI":"10.1186\/s12981-025-00803-y","article-title":"Barriers and pathways to re-engage people with HIV and substance use in medical care: a qualitative study among persons with lived experience","volume":"22","author":"Moitra","journal-title":"AIDS Res Ther"},{"issue":"1","key":"R111","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-22090-y","article-title":"Does travel time matter?: predictors of transportation vulnerability and access to HIV care among people living with HIV in South Carolina","volume":"25","author":"Harrison","journal-title":"BMC Public Health"},{"issue":"5","key":"R112","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1097\/JNC.0000000000000249","article-title":"Barriers to HIV care by viral suppression status among US adults with HIV: findings from the Centers for Disease Control and Prevention medical monitoring project","volume":"32","author":"Dasgupta","journal-title":"J Assoc Nurses AIDS Care"},{"key":"R113","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2024.101531","article-title":"Network meta-analysis: the way forward for evidence-based decisions","volume":"26","author":"Jaiswal","journal-title":"Clin Epidemiol Glob Health"},{"issue":"5","key":"R114","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/QAI.0000000000003449","article-title":"The effect of real-time medication monitoring-based digital adherence tools on adherence to antiretroviral therapy and viral suppression in people living with HIV: a systematic literature review and meta-analysis","volume":"96","author":"Msosa","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"R115","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1097\/EDE.0000000000001633","article-title":"An overview of current methods for real-world applications to generalize or transport clinical trial findings to target populations of interest","volume":"34","author":"Ling","journal-title":"Epidemiology"},{"issue":"11","key":"R116","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol32110629","article-title":"A narrative review of the strengths and limitations of real-world evidence in comparison to randomized clinical trials: what are the opportunities in thoracic oncology for real-world evidence to shine?","volume":"32","author":"Ellis","journal-title":"Curr Oncol"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2026\/1\/e81019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:26:36Z","timestamp":1785536796000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e81019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":116,"URL":"https:\/\/doi.org\/10.2196\/81019","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"v28i9903e81019"}}